Health Information Management

Q/A: Using modifier -59 for EKGs

APCs Insider, March 12, 2010

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Q: Should we use CPT modifier -59 (distinct procedural service) for a preoperative EKG performed on an outpatient the day of the primary procedure? And may we append it for a postoperative EKG is performed later in the day after an outpatient returns to his or her room?
 
A: Your question seems to address resolution of an NCCI edit between the EKG and another procedure. and whether you should automatically apply modifier -59 to the EKG to allow for separate APC payment from the other procedure
 
One cannot determine whether modifier -59 is appropriate for the EKG merely because it was performed preoperatively or postoperatively. You must analyze other factors, such as the physician order for the EKG, physician intent, and any clinical indications for the EKG. Did a complication develop postoperatively or was the EKG a routine or normal part of managing the care of the patient for the performed procedure?
 
Performance of any test, procedure, or service requires a medically necessary and documented reason. Modifier -59 may be appropriate if documentation in the record indicates that the EKG was ordered before the other procedure was scheduled and the EKG results were used to determine the medical need for the other procedure. Modifier -59 also may be appropriate if documentation indicates that the patient had a complication after the procedure and an EKG was appropriate to assess it.
 
However, without review of the actual documentation for the specific situation, we cannot make an exact determination.



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